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How to use or fill out the CCDF Discrepancy Childcare Statement of Services Form
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the 'Weeks of Service' dates, specifying the beginning and ending dates for the service period.
- Fill in the 'Provider EIN/SSN' and 'Childcare Provider Name' fields to identify your childcare provider.
- Complete the addresses for both the childcare provider and parent/guardian, ensuring all city, state, and zip code information is accurate.
- In the 'Description of Discrepancy' section, detail any issues encountered during service weeks, including specific days and codes related to card issues or POS not installed.
- For each week listed, record attendance times in 'Time IN' and 'Time OUT', noting whether they are a.m. or p.m., along with total hours worked.
- Finally, ensure both parent/guardian and provider signatures are completed in blue ink before submitting the form.
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| 2005 | 4.9 Satisfied (434 Votes) |
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